Excess Deaths From End-Stage Kidney Disease Early in Pandemic
An excess of 7000 to 10  000 deaths from end-stage kidney disease (ESKD) occurred during the first several months of the COVID-19 pandemic, according to data based on ESKD mortality trends from 2016 through 2019. (Source: JAMA)
Source: JAMA - July 27, 2021 Category: General Medicine Source Type: research

Resurgence of Pertussis Linked With Switch to Acellular Vaccine
The emergence of Bordetella pertussis strains that lack the common antigen pertactin is likely driven by the switch decades ago to newer, less effective vaccines, a study published in Emerging Infectious Diseases has suggested. (Source: JAMA)
Source: JAMA - July 27, 2021 Category: General Medicine Source Type: research

Jama
(Source: JAMA)
Source: JAMA - July 27, 2021 Category: General Medicine Source Type: research

Does This Adult Patient Have Hypertension?
This Rational Clinical Examination systematic review summarizes studies that examined the accuracy of current methods of blood pressure measurement, including home and office monitoring, compared with ambulatory blood pressure monitoring as the reference standard for diagnosing hypertension in patients not receiving treatment for hypertension. (Source: JAMA)
Source: JAMA - July 27, 2021 Category: General Medicine Source Type: research

The Race We Already Lost
In this narrative medicine essay, a resident in medicine and pediatrics learns in her last year of medical school that her physician father has metastatic liver cancer and hopes that for just a day or a little longer the 2 could share the title doctor. (Source: JAMA)
Source: JAMA - July 27, 2021 Category: General Medicine Source Type: research

Time Limits
They ’re on mute is off, they can see you briefly cutting in and out of the room for 15 minutes through glass screens on camera watching from afar isn’t the same as touching together at last breath into the deadly air you expire dying alone is safe and sad to say this but you have to die now without anyone but me. (Source: JAMA)
Source: JAMA - July 27, 2021 Category: General Medicine Source Type: research

Patient Information: Cardiac Rehabilitation
This JAMA Patient Page describes the goals of cardiac rehabilitation, its 3 phases, and which patients benefit from it. (Source: JAMA)
Source: JAMA - July 27, 2021 Category: General Medicine Source Type: research

7- vs 14-Day Antibiotic Therapy in Afebrile Men With Urinary Tract Infection
This randomized clinical trial assesses the effect of 14-day antibiotic treatment vs 7 days of antibiotic treatment plus 7 days of placebo among afebrile men with urinary tract infection. (Source: JAMA)
Source: JAMA - July 27, 2021 Category: General Medicine Source Type: research

Effect of a Quality Improvement Intervention on Outcomes and Care Quality for Patients With HFrEF
This cluster randomized trial evaluates the effect of a hospital and postdischarge quality improvement intervention vs usual care on time to heart failure rehospitalization or death, and quality of care, among patients with heart failure and reduced ejection fraction in the US. (Source: JAMA)
Source: JAMA - July 27, 2021 Category: General Medicine Source Type: research

Filgotinib Induces and Maintains Ulcerative Colitis Remission
Filgotinib induced and maintained clinical remission among patients with moderate to severe ulcerative colitis who had not responded to other therapies in a phase 2b and 3 trial published in The Lancet. The oral Janus kinase 1 preferential inhibitor has been previously evaluated in patients with rheumatoid arthritis, psoriatic arthritis, and ankylosing spondylitis. (Source: JAMA)
Source: JAMA - July 27, 2021 Category: General Medicine Source Type: research

Fewer Cardiovascular Events With Intensive Blood Pressure Control
The final report of the landmark Systolic Blood Pressure Intervention Trial (SPRINT) confirmed the benefits of intensive blood pressure control. (Source: JAMA)
Source: JAMA - July 27, 2021 Category: General Medicine Source Type: research

MDMA-assisted Therapy Highly Effective for PTSD
Supportive therapy together with 3,4-methylenedioxymethamphetamine (MDMA) —also known as the recreational drug ecstasy—significantly reduced severe posttraumatic stress disorder (PTSD) symptoms in a phase 3 multisite clinical trial. MDMA-assisted therapy has the “potential to dramatically transform treatment for PTSD,” the researchers wrote in Nature Medicine. (Source: JAMA)
Source: JAMA - July 27, 2021 Category: General Medicine Source Type: research

Tai Chi Reduces Waist Size Among Older Adults
Tai chi was as effective as conventional exercise for reducing central obesity in middle-aged and older adults, according to a trial published in the Annals of Internal Medicine. The authors recommended incorporating the gentle mind-body exercise into physical activity guidelines for older people. (Source: JAMA)
Source: JAMA - July 27, 2021 Category: General Medicine Source Type: research

Blinatumomab vs Chemotherapy Among Children With Relapsed Acute Lymphoblastic Leukemia —Reply
In Reply We concur with Dr Shibusawa and colleagues that some authors have suggested that the presence of a high percentage of regulatory T cells in peripheral blood was associated with a lower probability of response to blinatumomab. However, we are not aware of any study indicating that a high percentage of regulatory T cells can affect the probability of response to chemotherapy. In our randomized clinical trial, blinatumomab was superior to chemotherapy for event-free survival in children with relapsed B-ALL. Therefore, the hypothesis raised by Shibusawa and colleagues does not explain the improved outcomes for patient...
Source: JAMA - July 27, 2021 Category: General Medicine Source Type: research

Effect of Ventral vs Dorsal Spinal Surgery in Patients With Cervical Spondylotic Myelopathy —Reply
In Reply We agree with Dr Inose and colleagues that fusion is not always necessary after a dorsal decompression for cervical myelopathy. To clarify, in our study, we excluded patients with C2 to C7 kyphosis greater than 5 ° measured using a standing cervical radiograph with the patient in extension. We did not report the length of operative time or estimated blood loss during these surgeries, but we plan to include these data in a future study focusing on differences in cost between the ventral and dorsal cervical s pinal operations. A study site coordinator (blinded to patient randomized group) evaluated each patient ...
Source: JAMA - July 27, 2021 Category: General Medicine Source Type: research

Blinatumomab vs Chemotherapy Among Children With Relapsed Acute Lymphoblastic Leukemia
To the Editor In their recent study, Dr Locatelli and colleagues compared blinatumomab and standard intensive multidrug chemotherapy among children with high-risk B-cell acute lymphoblastic leukemia (B-ALL) in first relapse, before allogeneic hematopoietic stem cell transplant. Although the authors found an improved event-free survival in the blinatumomab group, several previous reports showed that an increased percentage of regulatory T cells in peripheral blood before the start of blinatumomab was associated with a reduced response to blinatumomab in patients with B-ALL relapse. A study investigating the use of flow cyto...
Source: JAMA - July 27, 2021 Category: General Medicine Source Type: research

Effect of Ventral vs Dorsal Spinal Surgery in Patients With Cervical Spondylotic Myelopathy
To the Editor The recently published CSM-S trial demonstrated that both ventral and dorsal surgical approaches performed equally well in patients with cervical spondylotic myelopathy. We have several comments about this study. First, while Dr Ghogawala and colleagues have used randomized clinical trials comparing the ventral and dorsal approaches, they refined the eligibility criteria to a patient population suitable for either surgical approach. The careful selection of patients provided clinical equipoise but also reduces the generalizability of their findings. For patients who met the study inclusion criteria, patient-r...
Source: JAMA - July 27, 2021 Category: General Medicine Source Type: research

Effect of Ventral vs Dorsal Spinal Surgery in Patients With Cervical Spondylotic Myelopathy
To the Editor We have several concerns about the recent study on the effect of ventral vs dorsal spinal surgery in patients with cervical spondylotic myelopathy. First, fusion is not always necessary after dorsal decompression if the vertebral disk and facet joints are maintained. In a Japanese survey from 2011, decompression alone was performed in 89.4% of surgeries for cervical spondylotic myelopathy. While additional fusion is necessary with cervical kyphosis or instability, an assessment of cervical instability was not specified in the study by Dr Ghogawala and colleagues. Moreover, although exclusion criteria in their...
Source: JAMA - July 27, 2021 Category: General Medicine Source Type: research

Effect of Systemic Hydrocortisone Started After Birth in Ventilated Preterm Infants on Mortality and Neurodevelopment
This follow-up to the STOP-BPD randomized clinical trial, which investigated the efficacy and safety of systemic hydrocortisone treatment initiated 7 to 14 days after birth in ventilator-dependent, very preterm infants in the Netherlands and Belgium at 36 weeks ’ postmenstrual age, examines the prespecified composite of death and neurodevelopmental impairment among these infants at 2 years’ corrected age. (Source: JAMA)
Source: JAMA - July 27, 2021 Category: General Medicine Source Type: research

Problems on Campus
Business executive, university trustee, former university administrator, and faculty member —Pake brings broad perspective to his examination of our universities’ present plight. As he views the campus scene, the faculty holds the seat of power, philosophically because faculty membership denotes expertise but practically because of tenure. The man with tenure is immune; he holds his po sition and draws his salary until he reaches mandatory retirement age. (Source: JAMA)
Source: JAMA - July 27, 2021 Category: General Medicine Source Type: research

Anabolic Therapy for Osteoporosis
This JAMA Insights reviews the use of anabolic medications to reduce the risk of osteoporosis-related fractures, including teriparatide, abaloparatide, and romosozumab. (Source: JAMA)
Source: JAMA - July 27, 2021 Category: General Medicine Source Type: research

Audio Highlights
Listen to the JAMA Editor ’s Audio Summary for an overview and discussion of the important articles appearing in this week’s issue of JAMA. (Source: JAMA)
Source: JAMA - July 27, 2021 Category: General Medicine Source Type: research

Higher Medicare Payments for In-home COVID-19 Vaccinations
The Centers for Medicare& Medicaid Services (CMS) recently increased payments for at-home COVID-19 vaccinations for Medicare beneficiaries. (Source: JAMA)
Source: JAMA - July 27, 2021 Category: General Medicine Source Type: research

Internet Access as a Social Determinant of Health
Using data from its social determinants of health database, the Agency for Healthcare Research and Quality (AHRQ) recently created an online visualization tool providing county-level information about people ’s internet access. (Source: JAMA)
Source: JAMA - July 27, 2021 Category: General Medicine Source Type: research

Ending Structural Racism in Federally Funded Research
National Institutes of Health (NIH) leaders, scientists, administrators, and staff, including Director Francis Collins, MD, PhD, recently published a framework to end structural racism in biomedical research. (Source: JAMA)
Source: JAMA - July 27, 2021 Category: General Medicine Source Type: research

Screening for Hepatitis C Virus
This JAMA Clinical Guidelines Synopsis summarizes the American Association for the Study of Liver Diseases/Infectious Diseases Society of America 2019 guideline update on screening for hepatitis C virus. (Source: JAMA)
Source: JAMA - July 27, 2021 Category: General Medicine Source Type: research

Shorter Courses of Antibiotics for Urinary Tract Infection in Men
Historically antibiotics were seen as miracle drugs. Over the past 70 years of widespread antibiotic use, however, there has been increasing recognition of some of the downsides of these drugs, including adverse effects and antimicrobial resistance. This awareness has prompted reconsideration of how to best use antibiotics including limiting use by disease indication or duration. Antibiotic durations for common infections were initially based on pathophysiology, expert opinion, and small observational studies. Recent clinical trials that randomly assigned patients to shorter courses or oral antibiotics for treatment of inf...
Source: JAMA - July 27, 2021 Category: General Medicine Source Type: research

Prioritizing Dissemination and Implementation Science in Cardiometabolic Medicine
Heart failure with reduced ejection fraction serves as a prototypical example in which advances in scientific discovery have not been fully realized in clinical practice. In recent years, stepwise progress in discovery science has afforded the availability of several disease-modifying therapies. Complete uptake of contemporary multidrug regimens is estimated to provide significant improvements in longevity and event-free survival. However, deep, pervasive gaps have remained in the optimal adoption of these therapies. Similar implementation gaps exist across other prevalent cardiometabolic conditions, including diabetes, ch...
Source: JAMA - July 27, 2021 Category: General Medicine Source Type: research

Incorrect Figure
This article was corrected online. (Source: JAMA)
Source: JAMA - July 27, 2021 Category: General Medicine Source Type: research

Renal Columns
This Arts and Medicine feature contains a kidney-themed crossword puzzle. (Source: JAMA)
Source: JAMA - July 27, 2021 Category: General Medicine Source Type: research

Patients in Afghanistan Face Growing Obstacles to Care
Ongoing violence and instability coupled with worsening economic conditions exacerbated by COVD-19 are jeopardizing access to health care in Afghanistan, according to a survey conducted in February by Doctors Without Borders, or M édecins Sans Frontières (MSF). (Source: JAMA)
Source: JAMA - July 20, 2021 Category: General Medicine Source Type: research

Urgent Need to Reduce Heart Disease Among Women Worldwide
One-third of women globally die of cardiovascular disease, yet women too often go undiagnosed and untreated, according to a report by a commission of 17 women experts from 11 countries. (Source: JAMA)
Source: JAMA - July 20, 2021 Category: General Medicine Source Type: research

Antibiotic Use in UK ’s COVID-19 Patients Often Unnecessary
Although few patients hospitalized with COVID-19 have a co-occurring bacterial infection, a recent study showed that a large proportion treated in UK hospitals receive antibiotics that often aren ’t necessary. (Source: JAMA)
Source: JAMA - July 20, 2021 Category: General Medicine Source Type: research

Jama
(Source: JAMA)
Source: JAMA - July 20, 2021 Category: General Medicine Source Type: research

To Err Is Human, to Apologize Is Hard
In this narrative medicine essay, a family physician asks the doctors who for 5 months could not pinpoint the cause of her son ’s agonizing headaches to apologize and, when most could not, asks that the medical community shift focus from promoting a false sense of perfection to one that embraces humility enough to apologize as essential to the healing process. (Source: JAMA)
Source: JAMA - July 20, 2021 Category: General Medicine Source Type: research

Javits Center
On the west side of Manhattan, you camouflage by wearing black. That's our uniform. So the young Army Reservists, clothed in irregularly shaped blobs of mossy green and beige, neatly pressed, and fetching in their way, were anything but concealed   amidst the modernist glare and looming expanse. (Source: JAMA)
Source: JAMA - July 20, 2021 Category: General Medicine Source Type: research

Patient Information: Low Back Pain
This JAMA Patient Page describes low back pain and its diagnosis and treatment options. (Source: JAMA)
Source: JAMA - July 20, 2021 Category: General Medicine Source Type: research

Effect of Canakinumab vs Placebo on Survival Without IMV in Patients Hospitalized With Severe COVID-19
This clinical trial compares the efficacy of canakinumab vs placebo on survival without invasive mechanical ventilation (IMV) in patients hospitalized with severe COVID-19. (Source: JAMA)
Source: JAMA - July 20, 2021 Category: General Medicine Source Type: research

Medical Debt in the US, 2009-2020
This retrospective cohort analysis of credit reports for a nationally representative 10% panel of individuals estimates the amount of medical debt nationally and by geographic region and income group and its association with Medicaid expansion under the Affordable Care Act. (Source: JAMA)
Source: JAMA - July 20, 2021 Category: General Medicine Source Type: research

Metoclopramide Nasal Spray (Gimoti) for Diabetic Gastroparesis
This Medical Letter review summarizes the use of Gimoti, a nasal spray formulation of the dopamine-2 receptor antagonist metoclopramide, for relief of symptoms in adults with acute and recurrent diabetic gastroparesis. (Source: JAMA)
Source: JAMA - July 20, 2021 Category: General Medicine Source Type: research

Strategies to Overcome the Market Dominance of Hospitals —Reply
In Reply We agree that differences in fee-for-service reimbursements have incentivized hospitals to grow lucrative service lines that cross-subsidize less lucrative services, such as general medicine, geriatrics, pediatrics, and behavioral health. This trend has become especially apparent during the COVID-19 pandemic, as we have previously discussed. We also agree with Dr Kornitzer ’s suggestion that value-based reimbursement models, if appropriately risk adjusted, may help encourage hospitals to compete on the basis of cost-effectiveness and quality of care rather than on the volume or relative value units of servic...
Source: JAMA - July 20, 2021 Category: General Medicine Source Type: research

Backstop Price Caps in Commercial Health Care Markets —Reply
In Reply Mr Lusk and Dr McDevitt argue that backstop price caps on the highest of health care prices would be “a blunt instrument for restraining prices.” Their assessment is based on 2 misperceptions of the caps we discussed in our recent Viewpoint. First, the approach we outlined would not cut prices equally across the board for all services. On the contrary, backstop price caps are intended to be ser vice specific, so that the amount trimmed depends on the amount by which the price for a specific service exceeds the cap. By design, backstop price caps would apply only to the highest prices within each servic...
Source: JAMA - July 20, 2021 Category: General Medicine Source Type: research

Strategies to Overcome the Market Dominance of Hospitals
To the Editor In their recent Viewpoint, Dr Kocher and colleagues illuminated the concerning trend of hospital-dominated markets that has contributed to unsustainable growth in US health care costs. However, by focusing on managing vertical and horizontal consolidation, they addressed the symptom rather than the underlying disease. Through acquisition and organic growth, hospitals now employ more than one-third of physicians, driven largely by an economic model whereby the razor-thin profit margins of hospitals depend on highly reimbursed elective procedures to cross-subsidize essential but poorly reimbursed services, such...
Source: JAMA - July 20, 2021 Category: General Medicine Source Type: research

Backstop Price Caps in Commercial Health Care Markets
To the Editor In their recent Viewpoint about regulation of health care prices, the authors claimed that instituting a price backstop for commercial insurance markets would limit the ability of consolidated health systems to exploit their growing market power. Although this approach has many virtues, as described, a flat backstop would serve as a blunt instrument for restraining prices. (Source: JAMA)
Source: JAMA - July 20, 2021 Category: General Medicine Source Type: research

Current Comment
(Source: JAMA)
Source: JAMA - July 20, 2021 Category: General Medicine Source Type: research

Novel Lipid-Lowering Therapies to Reduce Cardiovascular Risk
This JAMA Insights Clinical Update reviews lipid-lowering therapies prescribed to reduce cardiovascular risk, including statins and ezetimibe, as well as novel therapies such as PCSK-9 inhibitors, bempedoic acid, icosapent ethyl, and inclisiran. (Source: JAMA)
Source: JAMA - July 20, 2021 Category: General Medicine Source Type: research

Challenges of Accuracy in Germline Clinical Sequencing Data
This Genomics and Precision Health article explains how genetic testing has evolved from detection of prespecified and unknown variants to assessing entire genomes to establish diagnoses using high-throughput sequencing. (Source: JAMA)
Source: JAMA - July 20, 2021 Category: General Medicine Source Type: research

Audio Highlights
Listen to the JAMA Editor ’s Audio Summary for an overview and discussion of the important articles appearing in this week’s issue of JAMA. (Source: JAMA)
Source: JAMA - July 20, 2021 Category: General Medicine Source Type: research

Treatment Approved for “Undruggable” Lung Cancer
The FDA has approved sotorasib for the 13% of patients whose non –small cell lung cancer has the KRAS G12C variant that confers resistance to systemic therapy. Sotorasib is a small molecule that specifically inhibits the KRAS G12C protein, which leads to uncontrolled cell growth. It is indicated for adults whose cancer hasn’t responded to at least 1 type of s ystemic therapy. (Source: JAMA)
Source: JAMA - July 20, 2021 Category: General Medicine Source Type: research

FDA: Stop Using Medtronic ’s Heartware Ventricular Assist Device
After more than 100 complaints of malfunctions involving Medtronic ’s Heartware Ventricular Assist Device (HVAD) that resulted in 14 deaths and 13 device removals, the FDA has urged physicians not to use the device. The company simultaneously announced that it had ceased sales and distribution. (Source: JAMA)
Source: JAMA - July 20, 2021 Category: General Medicine Source Type: research